Provider Demographics
NPI:1699101824
Name:CHOI, JAEYONG
Entity type:Individual
Prefix:
First Name:JAEYONG
Middle Name:
Last Name:CHOI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAE
Other - Middle Name:Y
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:600 WEST 246TH ST.
Mailing Address - Street 2:APT 205
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-509-7672
Mailing Address - Fax:
Practice Address - Street 1:600 WEST 246TH ST.
Practice Address - Street 2:APT 205
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:718-509-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY600256-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse